Publications

Publications

Nurses Improving Care for Health Systems Elders (NICHE): An evidence-based professional practice model for an aging nation

Gilmartin, M. J. (2023). Geriatric Nursing, 53, 310-312. 10.1016/j.gerinurse.2023.08.002
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Abstract
Nurses Improving Care for Healthsystems Elders (NICHE), one of the original geriatric care models, enhances the overall quality and safety of nursing care provided to older adults in hospital and post-acute care settings. NICHE is a relatively low-cost, high-impact investment in the nursing workforce to improve performance on the nurse-sensitive quality indicators including falls, pressure injuries, medication safety, urinary incontinence, restraint reduction, delirium identification and management, reducing preventable readmissions, among others. NICHE also serves as a foundation to enhance nursing care to achieve national accreditation standards for a number of geriatric and nursing quality programs.

Nurses Leading the Way: Insights From the 2023 AcademyHealth Interdisciplinary Research Group on Nursing Issues Annual Meeting

Smith, J. M., Annis, A. M., Courtwright, S. E., Ghazal, L. V., Girouard, S., Jones, D., Ma, C., McGee, B. T., Nikpour, J., Riman, K. A., Root, M. C., Smith, J. G., Thompson, R. A., Turi, E., Cary, M., Carthon, J. M. B., Germack, H., Lucero, R., Edmond, L., … Kurtzman, E. T. (2023). Journal of Nursing Regulation, 14(2), 57-62. 10.1016/S2155-8256(23)00093-5

Nurses, Psychological Distress, and Burnout: Is There an App for That?

Murali, K. P., Brody, A. A., & Stimpfel, A. W. (2023). Annals of the American Thoracic Society, 20(10), 1404-1405. 10.1513/AnnalsATS.202307-629ED

Nurses’ knowledge of heart failure assessment and management: A cross-sectional survey

Wang, Z., Walsh, S., Tocchi, C., Zhang, Y., & Chyun, D. (2023). Heart and Lung, 58, 82-90. 10.1016/j.hrtlng.2022.11.008
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Abstract
Background: Nurses’ knowledge of heart failure (HF) is highly variable, ranging from expert to poor, potentially leading to inadequate self-care. Objectives: (1) document the knowledge variation of HF assessment and management among specialist and generalist nurses; (2) determine factors that may be associated with nurses’ knowledge; and (3) describe nurses’ views of knowledge deficits and ways to improve nurses’ knowledge to better meet the needs educational interventions. Method: Members of the American Association of Heart Failure Nurses and Registered Nurses were invited to participate in a cross-sectional survey. Independent samples t-test, chi-square, and linear regression were used for quantitative analysis. Text analysis was applied to analyze the themes of qualitative comments. Results: A total of 918 nurses completed the survey. Specialist nurses had higher scores than generalist nurses with statistically significant F-test for diet, fluid, signs/symptoms, medication, and exercise. Both specialist and generalist nurses were least knowledgeable about dry weight, asymptomatic hypotension, and transient dizziness. Being a specialist nurse was associated with higher level of knowledge scores. Years of experience and race were significant factors associated with knowledge scores in generalist nurses. Confidence level and race were significant predictors for specialist nurses. Three themes emerged regarding the cause of nurses’ insufficient knowledge and several approaches were provided. Conclusions: Specialist nurses are not only knowledgeable, but their knowledge levels are less variable compared to generalist nurses. There is a need to identify additional factors that may potentially influence nurses’ knowledge, contributing to the effectiveness of interventions.

Nursing Home Reform in the Context of National Long-Term Care Services and Policy: The Devil in the Details of the National Academies Report

Degenholtz, H. B., Travers, J. L., Zimmerman, S., Teresi, J., Calkins, M., & Sloane, P. D. (2023). Journal of the American Geriatrics Society, 71(2), 357-361. 10.1111/jgs.18273

Nutrition in Lifestyle Psychiatry

Merlo, G., & Bachtel, G. (2023). In Lifestyle Psychiatry (1–, pp. 230-252). CRC Press. 10.1201/b22810-22
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Abstract
An expanding body of research indicates that poor nutrition can change the function of the brain and alter individual behavior and mental health status. The brain is the most energy-consuming organ in the human body. Therefore, maintaining and optimizing brain health, mental health, and psychological functioning depend on a constant supply of nutrients. Data demonstrate that inadequate quality or quantity of nutrition is associated with an increased risk of mental health problems. Lifestyle psychiatry is an approach that aims to address underlying causes or contributing factors to poor mental health and/or mental health conditions, including nutrition. This chapter will discuss nutrition as an integral component of lifestyle psychiatry, as well as a key determinant and factor in mental health outcomes and outcomes for those with mental health disorders. A lifestyle psychiatry approach can help to improve patient outcomes, prevent the onset of mental health and brain health conditions, and enhance the management and treatment of mental health problems by promoting healthy dietary patterns, addressing nutritional deficiencies, and incorporation nutrition-related interventions into clinical practice.

One accurate measurement is worth 1000 expert opinions—Assessing quality care in assisted living

David, D., & Brody, A. A. (2023). Journal of the American Geriatrics Society, 71(5), 1358-1361. 10.1111/jgs.18284

Outcomes of a National Training Curriculum to Advance Generalist Level Palliative Care

Ferrell, B. R., Paice, J. A., Coyne, P. J., Economou, D., Thaxton, C. A., Wholihan, D., Battista, V., & Haskamp, A. (2023). Journal of Palliative Medicine, 26(2), 228-234. 10.1089/jpm.2022.0262
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Abstract
Background: The adoption of palliative care as an integral component of health care has led to the need for generalist level providers, especially important in serious illnesses such as cancer. Objectives: The goals of this National Cancer Institute-funded training program were to (1) identify the eight domains of quality palliative care applied to oncology practice, (2) demonstrate skills for oncology advanced practice registered nurses (APRNs) in the domains of palliative care, and (3) develop goals for implementing the skills training in practice through process improvement, staff education, and clinical care. Design: The training program led by the End of Life Nursing Education Consortium (ELNEC) project included oncology APRNs in a three-day training course with one-year follow-up for ongoing support and to assess impact. Settings: Five training courses included 430 APRNs from 46 U.S states including both pediatric and adult oncology settings. The project included 25% minority participants. Measurement: Measures included participant goal implementation, course evaluations, and surveys to assess implementation and palliative care practices (precourse, 6 and 12 months postcourse). Results: The ELNEC oncology APRN training course resulted in changes in practice across domains, improved perceived effectiveness in clinical practice, and valuable insight regarding the challenges in generalist level palliative care implementation. Conclusion: The ELNEC oncology APRN course serves as a model for the palliative care field to advance generalist level practice. Future training efforts can build on this project to reach more oncology professionals and those in other areas of serious illness care.

Outcomes of home-based primary care for homebound older adults: A randomized clinical trial

Federman, A. D., Brody, A., Ritchie, C. S., Egorova, N., Arora, A., Lubetsky, S., Goswami, R., Peralta, M., Reckrey, J. M., Boockvar, K., Shah, S., Ornstein, K. A., Leff, B., DeCherrie, L., & Siu, A. L. (2023). Journal of the American Geriatrics Society, 71(2), 443-454. 10.1111/jgs.17999
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Abstract
Background: Homebound older adults are medically complex and often have difficulty accessing outpatient medical care. Home-based primary care (HBPC) may improve care and outcomes for this population but data from randomized trials of HBPC in the United States are limited. Methods: We conducted a randomized controlled trial of HBPC versus office-based primary care for adults ages ≥65 years who reported ≥1 hospitalization in the prior 12 months and met the Medicare definition of homebound. HBPC was provided by teams consisting of a physician, nurse practitioner, nurse, and social worker. Data were collected at baseline, 6- and 12-months. Outcomes were quality of life, symptoms, satisfaction with care, hospitalizations, and emergency department (ED) visits. Recruitment was terminated early because more deaths were observed for intervention patients. Results: The study enrolled 229 patients, 65.4% of planned recruitment. The mean age was 82 (9.0) years and 72.3% had dementia. Of those assigned to HBPC, 34.2% never received it. Intervention patients had greater satisfaction with care than controls (2.26, 95% CI 1.46–3.06, p < 0.0001; effect size 0.74) and lower hospitalization rates (−17.9%, 95% CI −31.0% to −1.0%; p = 0.001; number needed to treat 6, 95% CI 3–100). There were no significant differences in quality of life (1.25, 95% CI −0.39–2.89, p = 0.13), symptom burden (−1.92, 95% CI −5.22–1.37, p = 0.25) or ED visits (1.2%, 95% CI −10.5%–12.4%; p = 0.87). There were 24 (21.1%) deaths among intervention patients and 12 (10.7%) among controls (p < 0.0001). Conclusion: HBPC was associated with greater satisfaction with care and lower hospitalization rates but also more deaths compared to office-based primary care. Additional research is needed to understand the nature of the higher death rate for HBPC patients, as well as to determine the effects of HBPC on quality of life and symptom burden given the trial's early termination.

An overview and policy implications of national nurse identifier systems: A call for unity and integration

Chan, G. K., Cummins, M. R., Taylor, C. S., Rambur, B., Auerbach, D. I., Meadows-Oliver, M., Cooke, C., Turek, E. A., & Pittman, P. (Polly). (2023). Nursing Outlook, 71(2). 10.1016/j.outlook.2022.10.005
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Abstract
There is a clear and growing need to be able record and track the contributions of individual registered nurses (RNs) to patient care and patient care outcomes in the US and also understand the state of the nursing workforce. The National Academies of Sciences, Engineering, and Medicine report, The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity (2021), identified the need to track nurses’ collective and individual contributions to patient care outcomes. This capability depends upon the adoption of a unique nurse identifier and its implementation within electronic health records. Additionally, there is a need to understand the nature and characteristics of the overall nursing workforce including supply and demand, turnover, attrition, credentialing, and geographic areas of practice. This need for data to support workforce studies and planning is dependent upon comprehensive databases describing the nursing workforce, with unique nurse identification to support linkage across data sources. There are two existing national nurse identifiers– the National Provider Identifier and the National Council of State Boards of Nursing Identifier. This article provides an overview of these two national nurse identifiers; reviews three databases that are not nurse specific to understand lessons learned in the development of those databases; and discusses the ethical, legal, social, diversity, equity, and inclusion implications of a unique nurse identifier.

Pediatric Primary Care Mental Health Specialist Examination: Job Task Analysis

Hallas, D., Heuer, B., Sesay-Tuffour, S. A., & Foerster, L. A. (2023). Journal for Nurse Practitioners, 19(2). 10.1016/j.nurpra.2022.08.024
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Abstract
Developmental, behavioral, and mental health (DBMH) conditions among pediatric populations have increased in prevalence in primary care. Approximately 1 in 5 children have mental health conditions, but only 20% receive care. In October 2021, a national emergency in children's mental health was declared. The Pediatric Nursing Certification Board offers a pediatric primary care mental health specialist (PMHS) examination that validates the knowledge, skills, and abilities of certified nurse practitioners caring for children, adolescents, and young adults with DBMH conditions. This review describes the methodology, data analysis, and results of the job task analysis that ensures examination quality measuring preparedness to practice as a certified PMHS.

Perceived social cohesion and depressive symptoms among internal migrants in China: The mediating role of social adaptation

Qu, X., Qi, X., Wu, B., Yu, J., & Zhang, H. (2023). Frontiers in Public Health, 11. 10.3389/fpubh.2023.1096318
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Background: Internal migrants are exposed to higher risks of depressive symptoms due to migration-related stress. It has been recognized that perceived neighborhood social cohesion has direct and indirect associations with depressive symptoms. However, the pathway from perceived social cohesion to internal migrants' depressive symptoms was less discussed. Objectives: To assess mental health disparities among internal migrants. To investigate the association between social cohesion and depressive symptoms among urban-to-urban and rural-to-urban migrants and to examine the mediating role of social adaptation. Methods: Data from the “2017 Urbanization and New Migrant Survey” was used, including 2,584 internal migrants age 18–65 from 10 cities in China. Social cohesion was measured by a six-item modified Community-level Cohesion Scale. Depressive symptoms was measured using the Center for Epidemiological Studies Depression Scale, and social adaptation was assessed by a single-item question of migrants' adaptation to local life. Multivariate linear regression models were used to examine the association between social cohesion and depressive symptoms. Baron and Kenny's mediation tests were conducted to examine the mediating role of social adaptation on the association. All analyses were adjusted using sampling weights to account for this survey's sampling design. Results: Rural-to-urban migrants were found to have more clinically significant depressive symptoms, lower perceived social cohesion, and fair or low social adaptation than urban-to-urban migrants (all p < 0.001). Being rural-to-urban migrants as compared with urban-to-urban migrants [Odds Ratio (OR) = 1.46, 95% Confidence Interval (CI) = 1.456, 1.461, p < 0.001], had lower perceived social cohesion (OR = 1.46, 95% CI = 1.458, 1.463, p < 0.001), and poorer social adaptation (OR = 1.94, 95% CI = 1.932, 1.941, p < 0.001), are associated with higher odds of having clinically significant depressive symptoms. Social adaptation partially mediated the association between social cohesion and depressive symptoms by explaining 15.39% of its effect for urban-to-urban migrants and 18.97% for rural-to-urban migrants. Conclusions: Findings from this study reveal mental health inequalities among internal migrants and demonstrate the importance of social adaption on the association between social cohesion and depressive symptoms. Social strategies and public policies are needed to build a more cohesive community that serves both local residents and internal migrants, especially rural-to-urban migrants.

Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer’s Disease and Related Dementias: A Qualitative Study

Vaughan Dickson, V., Melnyk, H., Ferris, R., Leon, A., Arcila-Mesa, M., Rapozo, C., Chodosh, J., & Blaum, C. S. (2023). Clinical Nursing Research, 32(4), 752-758. 10.1177/10547738211067880
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Abstract
Many older adults with diabetes (DM) have co-occurring Alzheimer’s Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers (n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient’s cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time.

Place of Death from Cancer in US States with vs Without Palliative Care Laws

Quan Vega, M. L., Chihuri, S. T., Lackraj, D., Murali, K. P., Li, G., & Hua, M. (2023). JAMA Network Open, 6(6). 10.1001/jamanetworkopen.2023.17247
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Abstract
Importance: In the US, improving end-of-life care has become increasingly urgent. Some states have enacted legislation intended to facilitate palliative care delivery for seriously ill patients, but it is unknown whether these laws have any measurable consequences for patient outcomes. Objective: To determine whether US state palliative care legislation is associated with place of death from cancer. Design, Setting, and Participants: This cohort study with a difference-in-differences analysis used information about state legislation combined with death certificate data for 50 US states (from January 1, 2005, to December 31, 2017) for all decedents who had any type of cancer listed as the underlying cause of death. Data analysis for this study occurred between September 1, 2021, and August 31, 2022. Exposures: Presence of a nonprescriptive (relating to palliative and end-of-life care without prescribing particular clinician actions) or prescriptive (requiring clinicians to offer patients information about care options) palliative care law in the state-year where death occurred. Main Outcomes and Measures: Multilevel relative risk regression with state modeled as a random effect was used to estimate the likelihood of dying at home or hospice for decedents dying in state-years with a palliative care law compared with decedents dying in state-years without such laws. Results: This study included 7547907 individuals with cancer as the underlying cause of death. Their mean (SD) age was 71 (14) years, and 3609146 were women (47.8%). In terms of race and ethnicity, the majority of decedents were White (85.6%) and non-Hispanic (94.1%). During the study period, 553 state-years (85.1%) had no palliative care law, 60 state-years (9.2%) had a nonprescriptive palliative care law, and 37 state-years (5.7%) had a prescriptive palliative care law. A total of 3780918 individuals (50.1%) died at home or in hospice. Most decedents (70.8%) died in state-years without a palliative care law, while 15.7% died in state-years with a nonprescriptive law and 13.5% died in state-years with a prescriptive law. Compared with state-years without a palliative care law, the likelihood of dying at home or in hospice was 12% higher for decedents in state-years with a nonprescriptive palliative care law (relative risk, 1.12 [95% CI 1.08-1.16]) and 18% higher for decedents in state-years with a prescriptive palliative care law (relative risk, 1.18 [95% CI, 1.11-1.26]). Conclusions and Relevance: In this cohort study of decedents from cancer, state palliative care laws were associated with an increased likelihood of dying at home or in hospice. Passage of state palliative care legislation may be an effective policy intervention to increase the number of seriously ill patients who experience their death in such locations.

Poststroke activity engagement in community dwellers: Association with illness perceptions and perceived environment

Shi, Y., Howe, T. H., Halpin, P. F., & Wu, B. (2023). Clinical Rehabilitation, 37(1), 132-142. 10.1177/02692155221111926
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Abstract
Objectives: To investigate whether individuals’ poststroke activity engagement is associated with their perceptions of stroke, as well as their perceptions of physical and social environment. Design: Cross-sectional study. Setting: Participants were recruited from eight rehabilitation settings in Beijing, China. Participants: A total of 202 dyads of community dwellers with stroke and their primary caregivers. Main Measures: Activity engagement measured by the Assessment of Life Habits; stroke individuals’ and caregivers’ illness perceptions measured by the Stroke-Specific Illness Perceptions Questionnaire – Revised; and stroke individuals’ perceived social and physical environment measured by the Social Support Survey and abbreviated Neighborhood Environment Walkability Scale. Results: A total of 202 dyads of individuals with stroke and their caregivers participated in the study with mean ages of 61.3 (8.3) and 52.6 (11.6), respectively. On average, stroke individuals scored 7.61 (1.42) on the daily activities subscale, indicating that they completed personal level activities without assistance but with some difficulty. They scored 6.21 (2.21) on the social roles subscale, suggesting that individuals completed societal level activities with assistive devices and with some difficulty. Illness perceptions correlated significantly with personal level activity engagement (change in R-squared = 0.029; p = 0.049), and perceived accessibility and heterogeneity correlated significantly with societal level activity engagement (change in R-squared = 0.025; p = 0.011). Conclusions: Poststroke activity engagement is associated not only with stroke individuals’ performance skills but also with their perceptions of stroke, and how they perceive their physical environment. The findings may assist clinicians’ decision making when developing comprehensive, targeted interventions for improving activity engagement and maximizing recovery after stroke.

Posttraumatic Stress Disorder

Young, A., & Merlo, G. (2023). In Lifestyle Psychiatry (1–, pp. 342-353). CRC Press. 10.1201/b22810-33
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Abstract
Posttraumatic stress disorder (PTSD) can have profound physical, psychological, and social consequences. Recently, there has been an increase in research on how lifestyle factors, including exercise, nutrition, stress management (e.g., mindfulness), substance use, sleep, and social connectedness may impact psychological and physical health, as well as social outcomes, in those with PTSD. Although research in some of these areas is still limited, results indicate promise for lifestyle interventions in at least some aspects of PTSD treatment. This chapter will explore the evidence for the relevance of these factors with regard to PTSD and discuss any evidence-based lifestyle interventions indicated for PTSD prevention and management.

Potential sources of moral distress during COVID-19: Perspectives of hospice interdisciplinary teams

Jones, T., Lin, S. Y., Durga, A., Luth, E. A., Lassell, R. K., & Brody, A. A. (2023). Palliative and Supportive Care, 21(4), 644-650. 10.1017/S1478951522000633
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Abstract
OBJECTIVE: This study aimed to examine the impact of COVID-19 on hospice Interdisciplinary team (IDT) members' self-reported stress and identify possible sources of moral distress. METHODS: A cross-sectional survey was conducted using Qualtrics to understand the impact of COVID-19 on quality improvement initiative implementation and hospice IDT members' general and dementia-specific care provision. Directed qualitative content analysis was used to analyze hospice IDT members' responses from five open-ended survey questions that were indicative of stress and possible moral distress. RESULTS: The final sample consisted of 101 unique respondents and 175 comments analyzed. Three categories related to sources of moral distress based on hospice IDT member survey responses were identified: (1) impact of telehealth, personal protective equipment (PPE), and visit restrictions on relationships; (2) lack of COVID-19-specific skills; and (3) organizational climate. Sources of moral distress were categorized in 40% of all responses analyzed. SIGNIFICANCE OF RESULTS: This study is one of the first to document and confirm evidence of potential stress and moral distress amongst hospice IDT members during COVID-19. It is imperative given the possible negative impact on patient care and clinician well-being, that future research and interventions incorporate mechanisms to support clinicians' emotional and ethical attunement and support organizations to actively engage in practices that address clinician moral distress resulting from restrictive environments, such as the one necessitated by COVID-19.

The power of the language we use: Stigmatization of individuals and fellow nurses with substance use issues

Foli, K. J., Choflet, A., Matthias-Anderson, D., Mercer, M., Thompson, R. A., & Squires, A. (2023). Research in Nursing and Health, 46(1), 3-8. 10.1002/nur.22295

Prediction Performance of Feature Selectors and Classifiers on Highly Dimensional Transcriptomic Data for Prediction of Weight Loss in Filipino Americans at Risk for Type 2 Diabetes

Chang, L., Fukuoka, Y., Aouizerat, B. E., Zhang, L., & Flowers, E. (2023). Biological Research for Nursing, 25(3), 393-403. 10.1177/10998004221147513
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Abstract
Background: Accurate prediction of risk for chronic diseases like type 2 diabetes (T2D) is challenging due to the complex underlying etiology. Integration of more complex data types from sensors and leveraging technologies for collection of -omics datasets may provide greater insights into the specific risk profile for complex diseases. Methods: We performed a literature review to identify feature selection methods and machine learning models for prediction of weight loss in a previously completed clinical trial (NCT02278939) of a behavioral intervention for weight loss in Filipinos at risk for T2D. Features included demographic and clinical characteristics, dietary factors, physical activity, and transcriptomics. Results: We identified four feature selection methods: Correlation-based Feature Subset Selection (CfsSubsetEval) with BestFirst, Kolmogorov–Smirnov (KS) test with correlation featureselection (CFS), DESeq2, and max-relevance-min-relevance (MRMR) with linear forward search and mutual information (MI) and four machine learning algorithms: support vector machine, decision tree, random forest, and extra trees that are applicable to prediction of weight loss using the specified feature types. Conclusion: More accurate prediction of risk for T2D and other complex conditions may be possible by leveraging complex data types from sensors and -omics datasets. Emerging methods for feature selection and machine learning algorithms make this type of modeling feasible.

Prediction of Weight Loss to Decrease the Risk for Type 2 Diabetes Using Multidimensional Data in Filipino Americans: Secondary Analysis

Chang, L., Fukuoka, Y., Aouizerat, B. E., Zhang, L., & Flowers, E. (2023). JMIR Diabetes, 8. 10.2196/44018
Abstract
Abstract
Background: Type 2 diabetes (T2D) has an immense disease burden, affecting millions of people worldwide and costing billions of dollars in treatment. As T2D is a multifactorial disease with both genetic and nongenetic influences, accurate risk assessments for patients are difficult to perform. Machine learning has served as a useful tool in T2D risk prediction, as it can analyze and detect patterns in large and complex data sets like that of RNA sequencing. However, before machine learning can be implemented, feature selection is a necessary step to reduce the dimensionality in high-dimensional data and optimize modeling results. Different combinations of feature selection methods and machine learning models have been used in studies reporting disease predictions and classifications with high accuracy. Objective: The purpose of this study was to assess the use of feature selection and classification approaches that integrate different data types to predict weight loss for the prevention of T2D. Methods: The data of 56 participants (ie, demographic and clinical factors, dietary scores, step counts, and transcriptomics) were obtained from a previously completed randomized clinical trial adaptation of the Diabetes Prevention Program study. Feature selection methods were used to select for subsets of transcripts to be used in the selected classification approaches: support vector machine, logistic regression, decision trees, random forest, and extremely randomized decision trees (extra-trees). Data types were included in different classification approaches in an additive manner to assess model performance for the prediction of weight loss. Results: Average waist and hip circumference were found to be different between those who exhibited weight loss and those who did not exhibit weight loss (P=.02 and P=.04, respectively). The incorporation of dietary and step count data did not improve modeling performance compared to classifiers that included only demographic and clinical data. Optimal subsets of transcripts identified through feature selection yielded higher prediction accuracy than when all available transcripts were included. After comparison of different feature selection methods and classifiers, DESeq2 as a feature selection method and an extra-trees classifier with and without ensemble learning provided the most optimal results, as defined by differences in training and testing accuracy, cross-validated area under the curve, and other factors. We identified 5 genes in two or more of the feature selection subsets (ie, CDP-diacylglycerol-inositol 3-phosphatidyltransferase [CDIPT], mannose receptor C type 2 [MRC2], PAT1 homolog 2 [PATL2], regulatory factor X-associated ankyrin containing protein [RFXANK], and small ubiquitin like modifier 3 [SUMO3]). Conclusions: Our results suggest that the inclusion of transcriptomic data in classification approaches for prediction has the potential to improve weight loss prediction models. Identification of which individuals are likely to respond to interventions for weight loss may help to prevent incident T2D. Out of the 5 genes identified as optimal predictors, 3 (ie, CDIPT, MRC2, and SUMO3) have been previously shown to be associated with T2D or obesity.

Pressures in the Ivory Tower: An Empirical Study of Burnout Scores among Nursing Faculty

Boamah, S. A., Kalu, M., Stennett, R., Belita, E., & Travers, J. (2023). International Journal of Environmental Research and Public Health, 20(5). 10.3390/ijerph20054398
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Abstract
(1) Background: The COVID-19 pandemic has exacerbated incidents of burnout among academics in various fields and disciplines. Although burnout has been the subject of extensive research, few studies have focused on nursing faculty. This study aimed to investigate the differences in burnout scores among nursing faculty members in Canada. (2) Method: Using a descriptive cross-sectional design, data were collected via an online survey in summer 2021 using the Maslach Burnout Inventory general survey and analyzed using the Kruskal-Wallis test. (3) Result: Faculty members (n = 645) with full-time employment status, worked more than 45 h, and taught 3–4 courses reported high burnout (score ≥ 3) compared to those teaching 1–2 courses. Although education levels, tenure status or rank, being on a graduate committee, or the percentage of hours dedicated to research and services were considered important personal and contextual factors, they were not associated with burnout. (4) Conclusions: Findings suggest that burnout manifests differently among faculty and at varying degrees. As such, targeted approaches based on individual and workload characteristics should be employed to address burnout and build resilience among faculty to improve retention and sustain the workforce.

Prevalence and correlates of fear of recurrence among oral and oropharyngeal cancer survivors

Manne, S. L., Hudson, S. V., Preacher, K. J., Imanguli, M., Pesanelli, M., Frederick, S., Singh, N., Schaefer, A., & Van Cleave, J. H. (2023). Journal of Cancer Survivorship. 10.1007/s11764-023-01449-3
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Abstract
Purpose: Fear of recurrence (FoR) is a prevalent and difficult experience among cancer patients. Most research has focused on FoR among breast cancer patients, with less attention paid to characterizing levels and correlates of FoR among oral and oropharyngeal cancer survivors. The purpose was to characterize FoR with a measure assessing both global fears and the nature of specific worries as well as evaluate the role of sociodemographic and clinical factors, survivorship care transition practices, lifestyle factors, and depressive symptoms in FoR. Methods: Three hundred eighty-nine oral and oropharyngeal survivors recruited from two cancer registries completed a survey assessing demographics, cancer treatment, symptoms, alcohol and tobacco use, survivorship care practices, depression, and FoR. Results: Forty percent reported elevated global FoR, with similar percentages for death (46%) and health worries (40.3%). Younger, female survivors and survivors experiencing more physical and depressive symptoms reported more global fears and specific fears about the impact of recurrence on roles, health, and identity, and fears about death. Depression accounted for a large percent of the variance. Lower income was associated with more role and identity/sexuality worries, and financial hardship was associated with more role worries. Conclusions: FoR is a relatively common experience for oral and oropharyngeal cancer survivors. Many of its correlates are modifiable factors that could be addressed with multifocal, tailored survivorship care interventions. Implications for Cancer Survivors: Assessing and addressing depressive symptoms, financial concerns, expected physical symptoms in the first several years of survivorship may impact FoR among oral and oropharyngeal cancer survivors.

Prevalence and determinants of food insecurity during the 2022 COVID-19 related lockdown in Shanghai

Liu, Y., Li, G., Qi, X., Wu, B., Latkin, C. A., Tang, W., & Hall, B. J. (2023). Global Public Health, 18(1). 10.1080/17441692.2023.2246066
Abstract
Abstract
The SARS-CoV-2 coronavirus pandemic has led to increased food insecurity levels. This cross-sectional study examines the prevalence and determinants of food insecurity during the two-month (1 April to 1 June 2022) city-wide lockdown in Shanghai. The data was collected via an online questionnaire from 3230 adult Shanghai residents during the lockdown. Food insecurity was measured using an adapted version of the Household Food Insecurity Access Scale. Nearly 70% of participants reported being exposed to food insecurity. Using multivariable logistic regressions, we examined the associations between key correlates (i.e. age, income, lockdown-related income loss, migration, employment status, social capital, preparedness, and received social support) and overall food insecurity while adjusting for ethnicity, gender, education, household size, and marital status. Results showed that compared to local Shanghai residents, migrants (i.e, permanent migrants with Hukou (OR = 2.16), permanent migrants without Hukou (OR = 2.06), temporary migrants (OR = 2.74)), and participants with less than or greather than 50% lockdown-related income loss (OR = 2.60, OR = 3.09), were associated with higher odds of overall food insecurity. Participants with greater preparedness (OR = 0.66), greater bonding social capital (OR = 0.93), and greater bridging social capital (OR = 0.94), had lower odds of overall food insecurity. Targeted interventions are needed to enhance food resilience and health equity among vulnerable populations.

Prevalence and Incidence of Mild Cognitive Impairment in Adults with Diabetes in the United States

Zheng, Y., Ma, Q., Qi, X., Zhu, Z., & Wu, B. (2023). Diabetes Research and Clinical Practice, 205, 110976. 10.1016/j.diabres.2023.110976
Abstract
Abstract
BACKGROUND: Limited evidence exists about the prevalence and incidence of mild cognitive impairment (MCI) in individuals with diabetes in the U.S. We aimed to address such knowledge gaps using a nationally representative study dataset.METHOD: We conducted a secondary analysis from the Health and Retirement Study (HRS) (1996-2018). The sample for examining the prevalence of MCI was14,988, with 4,192 (28.0%) having diabetes, while the sample for the incidence was 21,824, with 1,534 (28.0%) having diabetes.RESULTS: Participants with diabetes had a higher prevalence of MCI than those without diabetes (19.9% vs. 14.8%; odds ratio [95% confidence interval] (OR[95%CI]): 1.468 [1.337, 1.611], p<.001). The incidence of MCI in participants with/without newly diagnosed diabetes was 42.9% vs. 31.6% after a mean 10-year follow-up, with the incidence rate ratio (IRR) [95%CI] (1.314 [1.213, 1.424], p<.001). Newly diagnosed diabetes was associated with elevated risks of MCI compared with non-diabetes, with the uncontrolled hazard ratio (HR) [95%CI] (1.498 [1.405, 1.597], p<.001).CONCLUSIONS: Using a nationally representative study data in the U.S., participants with diabetes had a higher prevalence and incidence of MCI than those without diabetes. Findings show the importance of developing interventions tailored to the needs of individuals with diabetes and cognitive impairment.

Primary Care at the Intersection of Lifestyle Interventions and Unhealthy Substance Use

Nakaishi, L., Sugden, S. G., & Merlo, G. (2023). American Journal of Lifestyle Medicine, 17(4), 494-501. 10.1177/15598276221111047
Abstract
Abstract
Primary care physicians are well-positioned to integrate lifestyle interventions into the management of patients with unhealthy substance use, who may also have mental and physical chronic health comorbidities. However, the COVID-19 pandemic exacerbated the U.S.’s poor state of health, revealing that its current approach to chronic disease management is neither effective nor sustainable. Today’s full spectrum comprehensive care model requires an expanded toolkit. Lifestyle interventions broaden current treatment approaches and may enhance Addiction Medicine care. Primary care providers have the potential to have the greatest impact on unhealthy substance use care because they are experts in chronic disease management and their frontline accessibility minimizes healthcare barriers. Individuals with unhealthy substance use are at an increased risk of chronic physical conditions. Incorporating lifestyle interventions with unhealthy substance use care at every level of medicine, from medical school through practice, normalizes both as part of the standard care of medicine and will drive evidence-based best practices to support patients through prevention, treatment, and reversal of chronic diseases.